芍药(三两) 甘草(二两,炙) 生姜(切) 茯苓 白术(各三两) 大枣(十二枚,擘) 上六味,以水八
升,煮取三升,去渣。温服一升,小便利则愈。此方专于利小便也。
服桂枝汤,或下之,仍头项强痛,翕翕发热,无汗,心下满微痛,小便不利者,桂枝去桂加茯苓白术
汤主之。头痛发热,桂枝症仍在也,以其无汗,则不宜更用桂枝。心下满,则用白术,小便不利,则用
茯苓,此症乃亡津液而有停饮者也。
凡方中有加减法,皆佐使之药,若去其君药,则另立方名,今去桂枝,而仍以桂枝为名,所不可解!殆
以此方虽去桂枝而意仍不离乎桂枝也。
桂枝汤原方去芍药,加蜀漆三两(洗去腥),牡蛎五两(熬),龙骨四两。上七味,以水一斗二升,先煮
蜀漆,减二升,纳诸药,煮取三升,去渣,温服一升。
伤寒脉浮,医以火迫劫之,亡阳必惊狂,以火劫其胸中之阳。起卧不安者,桂枝去芍药加蜀漆龙骨
牡蛎救逆汤主之。此与少阴汗出之亡阳迥别。盖少阴之亡阳,乃亡阴中之阳,故用四逆辈回其阳于肾中,
今乃以火遍汗,亡其阳中之阳,故用安神之品,镇其阳于心中。各有至理,不可易也。
去芍药,因阳虚不复助阴也;蜀漆去心腹邪积;龙骨、牡蛎治惊痫热气。
桂枝(一两,去皮) 甘草(二两,炙) 牡蛎(二两,熬) 龙骨(二两) 上四味,以水五升,煮取二升半,
去渣,温服八合,日三服。
脉浮宜以汗解,此治脉浮之总诀。用火灸之,误治。邪无从出,因火而盛,火反入内。病从腰以下必
重而痹,名火逆也。火气在上,则阴气独治于下,故重而痹。火逆下之,又误治。因烧针烦躁者,更误治,
下之虚其阴,烧针又益其阳,则胸中益烦躁不宁矣。桂枝甘草龙骨牡蛎汤主之。钲其阴气,散其火邪,上
下同治,前方惊狂,治重在心,故用蜀漆。此无惊狂象,故蜀漆不用。其症药大段相同。
芍药(三两) 甘草(二两,经蜜炙) 生姜(切片) 茯苓 白术(各三两) 大枣(十二枚,掰开) 以上六味药,用水八升,煎煮至剩余三升,滤去药渣。每次温服一升,小便通利后病即痊愈。此方专门用于通利小便。
服用桂枝汤后,或者经过攻下法治疗,仍然出现头项强痛、微微发热、无汗、胃脘部胀满且轻微疼痛、小便不通利的症状,应当用桂枝去桂加茯苓白术汤主治。头痛发热,说明桂枝证仍然存在,但因为无汗,所以不适宜再用桂枝。胃脘部胀满,所以使用白术;小便不通利,所以使用茯苓,这个病症是由于津液耗伤而有水饮停聚所致。
凡是方剂中有加减法的,都是佐使药的调整,如果去掉君药,则另立方名,现在去掉了桂枝,却仍然以桂枝命名,这是无法理解的!大概是因为此方虽然去掉了桂枝,但用意仍然不离乎桂枝汤的宗旨。
桂枝汤原方去掉芍药,加入蜀漆三两(洗净去腥味),牡蛎五两(煅制),龙骨四两。以上七味药,用水一斗二升,先煮蜀漆,减少二升水量,再加入其他药物,煎煮至剩余三升,滤去药渣,每次温服一升。
伤寒脉浮,医生用火疗强迫发汗,导致亡阳,必然出现惊恐狂乱、坐卧不安的症状,这是因为火疗劫夺了胸中的阳气。这种情况与少阴病出汗导致的亡阳截然不同。因为少阴的亡阳,是亡失阴中之阳,所以用四逆汤类方剂在肾中回阳;现在是因火疗遍身大汗,亡失了阳中之阳,所以用安神的药物,镇摄心中之阳。各有其深刻的道理,不可更改。
去掉芍药,是因为阳气虚衰不再需要助阴;蜀漆用来去除心腹部的邪气积聚;龙骨、牡蛎治疗惊痫和热气。
桂枝(一两,去皮) 甘草(二两,经蜜炙) 牡蛎(二两,煅制) 龙骨(二两) 以上四味药,用水五升,煎煮至剩余二升半,滤去药渣,每次温服八合,每日三次。
脉浮适宜用发汗法解除,这是治疗脉浮的总原则。如果用火灸治疗,属于误治。邪气无从排出,反而因火而亢盛,火邪反入体内。疾病从腰部以下必定沉重且麻木痹阻,称为火逆。火气在上,导致阴气独治于下,所以沉重且痹阻。对火逆证再用攻下法,又是误治。因烧针导致烦躁的,更是误治,攻下法使其阴气更虚,烧针又增加其阳气,那么胸中会更加烦躁不宁。此时应用桂枝甘草龙骨牡蛎汤主治。镇摄阴气,疏散火邪,上下同治。前一方(桂枝去芍药加蜀漆龙骨牡蛎救逆汤)治疗惊狂,重点在于心,所以用蜀漆。此方没有惊狂的表现,所以不用蜀漆。其症状和用药大体相同。
Shao Yao (3 liang) Gan Cao (2 liang, honey-fried) Sheng Jiang (sliced) Fu Ling Bai Zhu (each 3 liang) Da Zao (12 pieces, broken open). The above six herbs are decocted with 8 sheng of water until reduced to 3 sheng. Strain the dregs. Take 1 sheng warm. Recovery occurs when urination becomes smooth. This formula is specifically designed to promote diuresis.
After taking Gui Zhi Tang (Cinnamon Twig Decoction), or following purgation therapy, if there remains stiffness and pain in the head and neck, slight fever, absence of sweating, fullness and mild pain in the epigastrium, and difficulty in urination, Gui Zhi Qu Gui Jia Fu Ling Bai Zhu Tang (Cinnamon Twig Decoction without Cinnamon Twig plus Poria and Atractylodes Macrocephala Decoction) should be administered. Headache and fever indicate that the Gui Zhi syndrome still persists; however, due to the absence of sweating, Gui Zhi (Cinnamon Twig) is not suitable for use. Epigastric fullness warrants the use of Bai Zhu (Atractylodes Macrocephala Rhizome); difficulty in urination warrants the use of Fu Ling (Poria). This condition arises from fluid depletion accompanied by retained fluid retention (water accumulation).
In formulas where modifications are made, these typically involve auxiliary (Zuo Shi) herbs. If the sovereign (Jun) herb is removed, a new formula name should be established. Here, although Gui Zhi (Cinnamon Twig) is removed, retaining "Gui Zhi" in the name is inexplicable! It is likely that although Gui Zhi (Cinnamon Twig) is removed, the therapeutic intent remains aligned with Gui Zhi Tang (Cinnamon Twig Decoction).
Starting from the original Gui Zhi Tang (Cinnamon Twig Decoction), remove Shao Yao (Peony Root), add Shu Qi (3 liang, washed to remove fishy odor), Mu Li (5 liang, calcined), and Long Gu (4 liang). The above seven herbs are decocted with 12 sheng of water. First boil Shu Qi (Perilla Leaf) until the volume reduces by 2 sheng, then add the remaining herbs. Boil until reduced to 3 sheng. Strain the dregs. Take 1 sheng warm.
In Shang Han (Cold Damage) with a floating pulse, if a physician uses fire therapy to force sweating, it leads to Yang collapse (Wang Yang), inevitably causing fright, mania, restlessness, and inability to sit or lie comfortably. This results from fire therapy robbing the Yang qi of the chest. This differs significantly from Yang collapse associated with sweating in Shao Yin (Lesser Yin) disease. In Shao Yin, Yang collapse refers to the loss of Yang within Yin, so Si Ni Tang (Frigid Four Decoction) and similar formulas are used to restore Yang in the Kidney. Here, profuse sweating induced by fire causes the loss of Yang within Yang; thus, calming spirit herbs are used to anchor Yang in the Heart. Each approach has profound rationale and must not be altered.
Shao Yao (Peony Root) is removed because Yang deficiency no longer requires assistance in nourishing Yin; Shu Qi (Perilla Leaf) removes pathogenic accumulations in the heart and abdomen; Long Gu (Dragon Bone) and Mu Li (Oyster Shell) treat fright, epilepsy, and heat.
Gui Zhi (1 liang, bark removed) Gan Cao (2 liang, honey-fried) Mu Li (2 liang, calcined) Long Gu (2 liang). The above four herbs are decocted with 5 sheng of water until reduced to 2.5 sheng. Strain the dregs. Take 0.8 sheng warm, three times daily.
A floating pulse indicates that treatment should aim at resolving via sweating; this is the general principle for treating a floating pulse. Using moxibustion/fire is a misdirection. Pathogens have no outlet and become exacerbated by fire, causing fire pathogens to enter inward. Symptoms below the waist will certainly become heavy and bi-syndrome (numbness/obstruction), termed Huo Ni (Fire Reversal). Fire qi stays above, allowing Yin qi to dominate alone below, resulting in heaviness and obstruction. Applying purgation to Huo Ni (Fire Reversal) is another misdirection. Irritability caused by burning needles is yet another misdirection; purgation further depletes Yin, while burning needles exacerbates Yang, leading to increased irritability and unrest in the chest. In such cases, Gui Zhi Gan Cao Long Gu Mu Li Tang (Cinnamon Twig and Licorice with Dragon Bone and Oyster Shell Decoction) should be administered. It anchors Yin qi and disperses fire pathogens, treating both upper and lower aspects. The previous formula (Gui Zhi Qu Shao Yao Jia Shu Qi Long Gu Mu Li Jiu Ni Tang) focused on the Heart due to fright and mania, hence using Shu Qi (Perilla Leaf). This formula lacks signs of fright and mania, so Shu Qi (Perilla Leaf) is omitted. The symptoms and medications are largely similar.